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  5. Information About the Provision of Puberty Blockers to Trans Youth in the United Kingdom
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  5. Information About the Provision of Puberty Blockers to Trans Youth in the United Kingdom

Information About the Provision of Puberty Blockers to Trans Youth in the United Kingdom

Background

Across several countries, the provision of gender affirming medical treatment for trans youth has been restricted. Much of the opposition to adolescent transgender care has been ideologically motivated and reflects a wider attempt to restrict the rights of the LGBTQ+ community [1–3].

In the United Kingdom, the restrictions to gender affirming medical treatment have been centred around NHS England’s statement that puberty blockers will no longer be available for trans adolescents and will only be prescribed as part of clinical research [4]. Subsequently, several pharmacies in the United Kingdom have been apprehensive about prescribing puberty blockers for trans adolescents.

This aim of this article is to provide some clarity regarding the ethics, law, and evidence regarding the provision of puberty blockers for trans youth in the United Kingdom.

Is the provision of puberty blockers for trans youth illegal in the United Kingdom?

No, it is not illegal to provide puberty blockers for trans youth in the United Kingdom.

The restriction on puberty blockers for trans youth by NHS England is not a legal ban. It is not encoded in legislation. Rather, it is a policy proposition which states that puberty blockers will not be commissioned by NHS England as a treatment option for young people with gender incongruence. That is to say, young people will not be able to access puberty blockers through the NHS.

However, this does not restrict the provision of puberty blockers for trans youth through private prescriptions. Trans youth can still legally access puberty blockers through private prescriptions that are provided by services outside the NHS.

Indeed, in a legal complaint raised against the Tavistock and Portman NHS Foundation Trust in the United Kingdom in 2021, the Court of Appeal ruled that adolescents aged under sixteen can give informed consent to puberty blockers if they are deemed to possess the relevant competencies and understandings [5]. Therefore, the rights of trans youth to consent to puberty blockers actually has legal protection in the United Kingdom.

It is also worth noting that the NHS are still providing puberty blockers for cis youth who are deemed to be undergoing puberty too soon, are “growing too tall for their age”, or are “a bit young to be having periods”. Hence, the puberty blockers are not illegal in the United Kingdom and to make them illegal only for trans youth would amount to an injustice.

Of course, there are unfortunately areas in the world where legal bans on puberty blockers have been enforced, notably in the United States where numerous ideologically driven bills have been pushed to restrict the rights of the LGBTQ+ community. However, this sort of legal ban has not been enforced in the United Kingdom at the time of writing.

What are the consequences of withholding puberty blockers for trans youth?

A substantial amount of research has shown that gender affirming medical treatment, including puberty blockers, results in significant improvements in the mental health and social wellbeing of trans youth [6–15]. Moreover, lack of access to gender affirming medical treatment has been shown to result in very serious harms to trans people, including increased risks of depression, anxiety, and suicide [16, 17].

Therefore, withholding puberty blockers is very likely to cause significant harms to trans youth, including depression, anxiety, social withdrawal, and suicide.

Is the provision of puberty blockers to trans youth ethical?

Further to the aforementioned benefits of puberty blockers for trans youth and the serious harms of withholding puberty blockers, the withholding of puberty blockers from trans youth would violate their rights to determine their identities and would exacerbate injustices against the trans community. Accordingly, academic philosophers have argued that the provision of puberty blockers for trans youth is ethical and that the withholding of puberty blockers is unethical [18–21].

Gender is an aspect of one’s identity that falls within the sphere of one’s autonomy and right to self-determination. The provision of gender affirming medical treatment respects the rights of young people to attain their embodiment goals and determine their own futures. Accordingly, gender reassignment is a protected characteristic under the Equality Act 2010 [22]. Furthermore, the withholding of gender affirming healthcare from trans youth is contrary to the United Nations’ Convention on the Rights of the Child, particularly Article 8 (the right to an identity), Article 12 (the rights of children to have their views given due weight), and Article 13 (freedom of expression) [23].

What do other organisations say?

The decision by NHS England to stop commissioning puberty blockers for trans youth has been criticised by the World Professional Association for Transgender Health (WPATH), the Asia Professional Association for Transgender Health, (AsiaPATH), the European Professional Association for Transgender Health (EPATH), the Professional Association for Transgender Health of Aotearoa (PATHA), the United States Professional Association for Transgender Health (USPATH), and the Australian Professional Association for Transgender Health (AusPATH) [24, 25].

The provision of puberty blockers to trans youth is supported by the international professional organisations such as the World Professional Association for Transgender Health, the Endocrine Society, and University of California San Francisco, whose evidence-based guidelines are based on peer-reviewed research [25–28]. Several other organisations have also issued statements which support gender affirming medical treatment for trans youth and which condemn the recent restrictions to this treatment, including the American Academy of Pediatrics, the American College of Physicians, the American Psychological Association, and the World Medical Association [29–32].

References

  1. Hines, S. (2020). “Sex Wars and (Trans) Gender Panics: Identity and Body Politics in Contemporary UK Feminism”. Sociological Review, 68 (4): 699–717.
  2. Kraschel, K. L., Chen, A., Turban, J. L., and Cohen, I. G. (2022). “Legislation Restricting Gender-Affirming Care for Transgender Youth: Politics Eclipse Healthcare”. Cell Reports Medicine, 3 (8): 100719.
  3. McLean, C. (2021). “The Growth of the Anti-Transgender Movement in the United Kingdom. The Silent Radicalization of the British Electorate”. International Journal of Sociology, 51 (6): 473–482.
  4. NHS England (2023). Interim Clinical Policy: Puberty suppressing hormones for children and adolescents who have gender incongruence/dysphoria. London: NHS England. https://www.engage.england.nhs.uk/consultation/puberty-suppressing-hormones/
  5. Bell v. Tavistock (2021). EWCA Civ 1363 (Court of Appeal of England and Wales).
  6. Allen, L. R., Watson, L. B., Egan, A. M., and Moser, C. N. (2019). “Well-being and suicidality among transgender youth after gender-affirming hormones”. Clinical Practice in Pediatric Psychology, 7: 302–311.
  7. Bungener, S. L., de Vries, A. L. C., Popma, A., and Steensma, T. D. (2020). “Sexual experiences of young transgender persons during and after gender-affirmative treatment”. Pediatrics, 146: e20191411.
  8. de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). “Young adult psychological outcome after puberty suppression and gender reassignment”. Pediatrics, 134: 696–704.
  9. Chen, D., Berona, J., Chan, Y. M., Ehrensaft, D., Garofalo, R., Hidalgo, M. A., Rosenthal, S. M., Tishelman, A. C., and Olson-Kennedy, J. (2023). “Psychosocial functioning in transgender youth after 2 Years of hormones”. New England Journal of Medicine, 388: 240–250.
  10. Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., and Nelson, E. E. (2021). “Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys”. Psychoneuroendocrinology, 132: e105358.
  11. Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2022). “Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth”. Journal of Adolescent Health, 70: 643–649.
  12. Kuper, L. E., Stewart, S., Preston, S., Lau, M., and Lopez, X. (2020). “Body dissatisfaction and mental health outcomes of youth on gender affirming hormone therapy”. Pediatrics, 145: e20193006.
  13. Rew, L., Young, C. C., Monge, M., and Bogucka, R. (2021). “Review: Puberty blockers for transgender and gender diverse youth—A critical review of the literature”. Child and Adolescent Mental Health, 26: 3–14.
  14. Turban, J. L., King, D., Carswell, J. M., and Keuroghlian, A. S. (2020). “Pubertal suppression for transgender youth and risk of suicidal ideation”. Pediatrics, 145: e20191725.
  15. van der Miesen, A., Steensma, T. D., de Vries, A., Bos, H., and Popma, A. (2020). “Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers”. Journal of Adolescent Health, 66: 699–704.
  16. Tan, K. K. H., Byrne, J. L., Treharne, G. J., and Veale, J. F. (2023). “Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand”. Journal of Public Health, 45(2): e225–e233.
  17. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., and Ahrens, K. (2022). “Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care”. JAMA Network Open, 5: e220978.
  18. Ashley, F. (2022). “Adolescent medical transition is ethical: An analogy with reproductive health”. Kennedy Institute of Ethics Journal, 32(2): 127–171.
  19. Giordano, S., and Holm, S. (2020). “Is Puberty Delaying Treatment ‘Experimental Treatment’?” International Journal of Transgender Health, 21 (2): 113–121.
  20. Maung, H. H. (2024). “Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis”. Journal of Bioethical Inquiryhttps://doi.org/10.1007/s11673-023-10313-z
  21. Wenner, D. M., and George, B. R. (2021). “Not just a tragic compromise: The positive case for adolescent access to puberty-blocking treatment”. Bioethics, 35(9): 925–931.
  22. UK Legislation (2010). The Equality Act 2010. https://www.legislation.gov.uk/ukpga/2010/15/contents
  23. United Nations (1989). Convention on the Rights of the Child. United Nation Treaty Series, 1577: 3–178.
  24. WPATH, ASIAPATH, EPATH, PATHA, and USPATH (2022). Response to NHS England in the United Kingdomhttps://listloop.com/wpath/mail.cgi/archive/adhoc/20221125183220/
  25. AusPATH (2022). AusPATH statement about the Interim Service Specification for the Specialist Service for Children and Young People with Gender Dysphoria (Phase 1 Providers) by NHS England. https://auspath.org.au/2022/11/16/auspath-statement-about-the-interim-service-specification-for-the-specialist-service-for-children-and-young-people-with-gender-dysphoria-phase-1-providers-by-nhs-england/
  26. Centre of Excellence for Transgender Health (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people, 2nd edition, edited by Deutsch, M. B. University of California San Francisco.
  27. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline”. Journal of Clinical Endocrinology and Metabolism, 102: 3869–3903.
  28. World Professional Association for Transgender Health (2022a). “Standards of care for the health of transgender and gender diverse people, version 8”. International Journal of Transgender Health, 23: S1–S259.
  29. American Academy of Pediatrics (2022). Statement from the American Academy of Pediatrics and the Oklahoma Chapter of the American Academy of Pediatrics on gender-affirming carehttps://www.aap.org/en/news-room/news-releases/aap/2022/statement-from-the-american-academy-of-pediatrics-and-the-oklahoma-chapter-of-the-american-academy-of-pediatrics-on-gender-affirming-care/#:~:text=The%20American%20Academy%20of%20Pediatrics%2C%20along%20with%20its%20Oklahoma%20Chapter,transgender%20and%20gender%20diverse%20youth.
  30. American College of Physicians (2022). Attacks on gender-affirming and transgender health carehttps://www.acponline.org/advocacy/state-health-policy/attacks-on-gender-affirming-and-transgender-health-care.
  31. American Psychological Association (2024). APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care
  32. World Medical Association (2024). WMA Statement on Transgender People. https://www.wma.net/policies-post/wma-statement-on-transgender-people/

Updated on April 3, 2024

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